White Rock Medical Center

All Charges

Charge

Type

Setting

Price

DBM Cortical Fiber, 10cc

Facility

$9,006.02

Service Code	HCPCS C9359
Hospital Charge Code	992117
Hospital Revenue Code	278
Min. Negotiated Rate	$2,251.51
Max. Negotiated Rate	$4,503.01
Rate for Payer: Cash Price	$6,124.09
Rate for Payer: Cigna Commercial	$2,251.51
Rate for Payer: Multiplan Auto	$4,503.01
Rate for Payer: Multiplan Commercial	$4,503.01
Rate for Payer: Multiplan Workers Comp	$4,503.01
Rate for Payer: Scott and White EPO/PPO	$4,503.01

DC001640DC001645

Facility

$4,963.25

Service Code	HCPCS C1713
Hospital Charge Code	991069
Hospital Revenue Code	278
Min. Negotiated Rate	$446.69
Max. Negotiated Rate	$3,573.54
Rate for Payer: Amerigroup CHIP/Medicaid	$446.69
Rate for Payer: BCBS of TX Blue Advantage	$1,488.97
Rate for Payer: BCBS of TX Blue Essentials	$1,786.77
Rate for Payer: BCBS of TX PPO	$1,985.30
Rate for Payer: Cash Price	$3,375.01
Rate for Payer: Cigna Medicaid	$3,573.54
Rate for Payer: Molina CHIP/Medicaid	$3,573.54
Rate for Payer: Multiplan Auto	$2,481.62
Rate for Payer: Multiplan Commercial	$2,481.62
Rate for Payer: Multiplan Workers Comp	$2,481.62
Rate for Payer: Parkland Medicaid	$3,573.54
Rate for Payer: Scott and White EPO/PPO	$2,481.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,573.54
Rate for Payer: Superior Health Plan EPO	$675.00

DC001640DC001645

Facility

$4,963.25

Service Code	HCPCS C1713
Hospital Charge Code	991069
Hospital Revenue Code	278
Min. Negotiated Rate	$1,240.81
Max. Negotiated Rate	$2,481.62
Rate for Payer: Cash Price	$3,375.01
Rate for Payer: Cigna Commercial	$1,240.81
Rate for Payer: Multiplan Auto	$2,481.62
Rate for Payer: Multiplan Commercial	$2,481.62
Rate for Payer: Multiplan Workers Comp	$2,481.62
Rate for Payer: Scott and White EPO/PPO	$2,481.62

DC001660

Facility

$4,512.05

Service Code	HCPCS C1713
Hospital Charge Code	994016
Hospital Revenue Code	278
Min. Negotiated Rate	$1,128.01
Max. Negotiated Rate	$2,256.03
Rate for Payer: Cash Price	$3,068.19
Rate for Payer: Cigna Commercial	$1,128.01
Rate for Payer: Multiplan Auto	$2,256.03
Rate for Payer: Multiplan Commercial	$2,256.03
Rate for Payer: Multiplan Workers Comp	$2,256.03
Rate for Payer: Scott and White EPO/PPO	$2,256.03

DC001660

Facility

$4,512.05

Service Code	HCPCS C1713
Hospital Charge Code	994016
Hospital Revenue Code	278
Min. Negotiated Rate	$406.08
Max. Negotiated Rate	$3,248.68
Rate for Payer: Amerigroup CHIP/Medicaid	$406.08
Rate for Payer: BCBS of TX Blue Advantage	$1,353.62
Rate for Payer: BCBS of TX Blue Essentials	$1,624.34
Rate for Payer: BCBS of TX PPO	$1,804.82
Rate for Payer: Cash Price	$3,068.19
Rate for Payer: Cigna Medicaid	$3,248.68
Rate for Payer: Molina CHIP/Medicaid	$3,248.68
Rate for Payer: Multiplan Auto	$2,256.03
Rate for Payer: Multiplan Commercial	$2,256.03
Rate for Payer: Multiplan Workers Comp	$2,256.03
Rate for Payer: Parkland Medicaid	$3,248.68
Rate for Payer: Scott and White EPO/PPO	$2,256.03
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,248.68
Rate for Payer: Superior Health Plan EPO	$613.64

DC003285

Facility

$4,963.25

Service Code	HCPCS C1734
Hospital Charge Code	991198
Hospital Revenue Code	278
Min. Negotiated Rate	$1,240.81
Max. Negotiated Rate	$2,481.62
Rate for Payer: Cash Price	$3,375.01
Rate for Payer: Cigna Commercial	$1,240.81
Rate for Payer: Multiplan Auto	$2,481.62
Rate for Payer: Multiplan Commercial	$2,481.62
Rate for Payer: Multiplan Workers Comp	$2,481.62
Rate for Payer: Scott and White EPO/PPO	$2,481.62

DC003285

Facility

$4,963.25

Service Code	HCPCS C1734
Hospital Charge Code	991198
Hospital Revenue Code	278
Min. Negotiated Rate	$446.69
Max. Negotiated Rate	$3,573.54
Rate for Payer: Amerigroup CHIP/Medicaid	$446.69
Rate for Payer: BCBS of TX Blue Advantage	$1,488.97
Rate for Payer: BCBS of TX Blue Essentials	$1,786.77
Rate for Payer: BCBS of TX PPO	$1,985.30
Rate for Payer: Cash Price	$3,375.01
Rate for Payer: Cigna Medicaid	$3,573.54
Rate for Payer: Molina CHIP/Medicaid	$3,573.54
Rate for Payer: Multiplan Auto	$2,481.62
Rate for Payer: Multiplan Commercial	$2,481.62
Rate for Payer: Multiplan Workers Comp	$2,481.62
Rate for Payer: Parkland Medicaid	$3,573.54
Rate for Payer: Scott and White EPO/PPO	$2,481.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,573.54
Rate for Payer: Superior Health Plan EPO	$675.00

DC032110DC032100DC003290

Facility

$4,512.00

Service Code	HCPCS C1713
Hospital Charge Code	991055
Hospital Revenue Code	278
Min. Negotiated Rate	$406.08
Max. Negotiated Rate	$3,248.64
Rate for Payer: Amerigroup CHIP/Medicaid	$406.08
Rate for Payer: BCBS of TX Blue Advantage	$1,353.60
Rate for Payer: BCBS of TX Blue Essentials	$1,624.32
Rate for Payer: BCBS of TX PPO	$1,804.80
Rate for Payer: Cash Price	$3,068.16
Rate for Payer: Cigna Medicaid	$3,248.64
Rate for Payer: Molina CHIP/Medicaid	$3,248.64
Rate for Payer: Multiplan Auto	$2,256.00
Rate for Payer: Multiplan Commercial	$2,256.00
Rate for Payer: Multiplan Workers Comp	$2,256.00
Rate for Payer: Parkland Medicaid	$3,248.64
Rate for Payer: Scott and White EPO/PPO	$2,256.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,248.64
Rate for Payer: Superior Health Plan EPO	$613.63

DC032110DC032100DC003290

Facility

$4,512.00

Service Code	HCPCS C1713
Hospital Charge Code	991055
Hospital Revenue Code	278
Min. Negotiated Rate	$1,128.00
Max. Negotiated Rate	$2,256.00
Rate for Payer: Cash Price	$3,068.16
Rate for Payer: Cigna Commercial	$1,128.00
Rate for Payer: Multiplan Auto	$2,256.00
Rate for Payer: Multiplan Commercial	$2,256.00
Rate for Payer: Multiplan Workers Comp	$2,256.00
Rate for Payer: Scott and White EPO/PPO	$2,256.00

D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC

Facility

$38,932.90

Service Code	MSDRG 744
Min. Negotiated Rate	$14,536.58
Max. Negotiated Rate	$38,932.90
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$19,777.99
Rate for Payer: Amerigroup Medicare	$19,777.99
Rate for Payer: BCBS of TX Medicare	$19,777.99
Rate for Payer: Cigna Commercial	$26,392.41
Rate for Payer: Cigna Medicare	$19,777.99
Rate for Payer: Employer Direct Commercial	$19,777.99
Rate for Payer: Humana Medicare/TRICARE	$19,777.99
Rate for Payer: Molina Dual Medicare/Medicaid	$19,777.99
Rate for Payer: Molina Medicare	$19,777.99
Rate for Payer: Multiplan Auto	$38,932.90
Rate for Payer: Multiplan Commercial	$38,932.90
Rate for Payer: Multiplan Workers Comp	$38,932.90
Rate for Payer: Scott and White EPO/PPO	$17,929.62
Rate for Payer: Scott and White Medicare	$19,777.99
Rate for Payer: Superior Health Plan EPO	$19,777.99
Rate for Payer: Superior Health Plan Medicare	$19,777.99
Rate for Payer: Universal American Dual Medicare/Medicaid	$19,777.99
Rate for Payer: Universal American Medicare	$19,777.99
Rate for Payer: Wellcare Medicare	$19,777.99
Rate for Payer: Wellmed Medicare	$19,777.99

D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC

Facility

$21,612.50

Service Code	MSDRG 745
Min. Negotiated Rate	$9,196.84
Max. Negotiated Rate	$21,612.50
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$13,096.86
Rate for Payer: Amerigroup Medicare	$13,096.86
Rate for Payer: BCBS of TX Medicare	$13,096.86
Rate for Payer: Cigna Commercial	$14,651.00
Rate for Payer: Cigna Medicare	$13,096.86
Rate for Payer: Employer Direct Commercial	$13,096.86
Rate for Payer: Humana Medicare/TRICARE	$13,096.86
Rate for Payer: Molina Dual Medicare/Medicaid	$13,096.86
Rate for Payer: Molina Medicare	$13,096.86
Rate for Payer: Multiplan Auto	$21,612.50
Rate for Payer: Multiplan Commercial	$21,612.50
Rate for Payer: Multiplan Workers Comp	$21,612.50
Rate for Payer: Scott and White EPO/PPO	$9,953.12
Rate for Payer: Scott and White Medicare	$13,096.86
Rate for Payer: Superior Health Plan EPO	$13,096.86
Rate for Payer: Superior Health Plan Medicare	$13,096.86
Rate for Payer: Universal American Dual Medicare/Medicaid	$13,096.86
Rate for Payer: Universal American Medicare	$13,096.86
Rate for Payer: Wellcare Medicare	$13,096.86
Rate for Payer: Wellmed Medicare	$13,096.86

D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION W CC/MCC

Facility

$38,932.90

Service Code	MSDRG 744
Min. Negotiated Rate	$14,536.58
Max. Negotiated Rate	$38,932.90
Rate for Payer: BCBS of TX Blue Advantage	$14,536.58
Rate for Payer: BCBS of TX Blue Essentials	$17,442.21
Rate for Payer: BCBS of TX PPO	$19,380.98

D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION W/O CC/MCC

Facility

$21,612.50

Service Code	MSDRG 745
Min. Negotiated Rate	$9,196.84
Max. Negotiated Rate	$21,612.50
Rate for Payer: BCBS of TX Blue Advantage	$9,196.84
Rate for Payer: BCBS of TX Blue Essentials	$11,035.14
Rate for Payer: BCBS of TX PPO	$12,261.74

D-Dimer

Facility

$449.00

Service Code	HCPCS 85379
Hospital Charge Code	1605666
Hospital Revenue Code	305
Rate for Payer: Cash Price	$305.32

D-Dimer

Facility

$449.00

Service Code	HCPCS 85379
Hospital Charge Code	1605666
Hospital Revenue Code	305
Min. Negotiated Rate	$3.97
Max. Negotiated Rate	$323.28
Rate for Payer: Amerigroup CHIP/Medicaid	$3.97
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$10.18
Rate for Payer: Amerigroup Medicare	$10.18
Rate for Payer: BCBS of TX Blue Advantage	$134.70
Rate for Payer: BCBS of TX Blue Essentials	$161.64
Rate for Payer: BCBS of TX Medicare	$10.18
Rate for Payer: BCBS of TX PPO	$179.60
Rate for Payer: Cash Price	$305.32
Rate for Payer: Cash Price	$305.32
Rate for Payer: Cigna Medicaid	$323.28
Rate for Payer: Cigna Medicare	$10.18
Rate for Payer: Employer Direct Commercial	$10.18
Rate for Payer: Humana Medicare/TRICARE	$10.18
Rate for Payer: Molina CHIP/Medicaid	$323.28
Rate for Payer: Molina Dual Medicare/Medicaid	$10.18
Rate for Payer: Molina Medicare	$10.18
Rate for Payer: Multiplan Auto	$291.85
Rate for Payer: Multiplan Commercial	$291.85
Rate for Payer: Multiplan Workers Comp	$291.85
Rate for Payer: Parkland Medicaid	$323.28
Rate for Payer: Scott and White EPO/PPO	$12.72
Rate for Payer: Scott and White Medicare	$10.18
Rate for Payer: Superior Health Plan CHIP/Medicaid	$323.28
Rate for Payer: Superior Health Plan EPO	$10.18
Rate for Payer: Superior Health Plan Medicare	$10.18
Rate for Payer: Universal American Dual Medicare/Medicaid	$10.18
Rate for Payer: Universal American Medicare	$10.18
Rate for Payer: Wellcare Medicare	$10.18
Rate for Payer: Wellmed Medicare	$10.18

DDPB3D4 ICD COBALT DR MRI

Facility

$78,313.00

Service Code	HCPCS C1721
Hospital Charge Code	9395003
Hospital Revenue Code	278
Min. Negotiated Rate	$19,578.25
Max. Negotiated Rate	$39,156.50
Rate for Payer: Cash Price	$53,252.84
Rate for Payer: Cigna Commercial	$19,578.25
Rate for Payer: Multiplan Auto	$39,156.50
Rate for Payer: Multiplan Commercial	$39,156.50
Rate for Payer: Multiplan Workers Comp	$39,156.50
Rate for Payer: Scott and White EPO/PPO	$39,156.50

DDPB3D4 ICD COBALT DR MRI

Facility

$78,313.00

Service Code	HCPCS C1721
Hospital Charge Code	9395003
Hospital Revenue Code	278
Min. Negotiated Rate	$7,048.17
Max. Negotiated Rate	$56,385.36
Rate for Payer: Amerigroup CHIP/Medicaid	$7,048.17
Rate for Payer: BCBS of TX Blue Advantage	$23,493.90
Rate for Payer: BCBS of TX Blue Essentials	$28,192.68
Rate for Payer: BCBS of TX PPO	$31,325.20
Rate for Payer: Cash Price	$53,252.84
Rate for Payer: Cigna Medicaid	$56,385.36
Rate for Payer: Molina CHIP/Medicaid	$56,385.36
Rate for Payer: Multiplan Auto	$39,156.50
Rate for Payer: Multiplan Commercial	$39,156.50
Rate for Payer: Multiplan Workers Comp	$39,156.50
Rate for Payer: Parkland Medicaid	$56,385.36
Rate for Payer: Scott and White EPO/PPO	$39,156.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$56,385.36
Rate for Payer: Superior Health Plan EPO	$10,650.57

Debride Bone Each Additional 20 Sq cm

Facility

$4,412.00

Service Code	HCPCS 11047
Hospital Charge Code	7150797
Hospital Revenue Code	361
Min. Negotiated Rate	$397.08
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$397.08
Rate for Payer: BCBS of TX Blue Advantage	$1,323.60
Rate for Payer: BCBS of TX Blue Essentials	$1,588.32
Rate for Payer: BCBS of TX PPO	$1,764.80
Rate for Payer: Cash Price	$3,000.16
Rate for Payer: Cash Price	$3,000.16
Rate for Payer: Cigna Medicaid	$3,176.64
Rate for Payer: Molina CHIP/Medicaid	$3,176.64
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Parkland Medicaid	$3,176.64
Rate for Payer: Scott and White EPO/PPO	$2,206.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,176.64
Rate for Payer: Superior Health Plan EPO	$600.03

Debride Bone Each Additional 20 Sq cm

Facility

$4,412.00

Service Code	HCPCS 11047
Hospital Charge Code	7150797
Hospital Revenue Code	361
Rate for Payer: Cash Price	$3,000.16

Debride Bone First 20 Sq cm or Less

Facility

$6,480.96

Service Code	HCPCS 11044
Hospital Charge Code	9900084
Hospital Revenue Code	360
Min. Negotiated Rate	$566.62
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$566.62
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,659.12
Rate for Payer: Amerigroup Medicare	$1,659.12
Rate for Payer: BCBS of TX Blue Advantage	$2,292.24
Rate for Payer: BCBS of TX Blue Essentials	$2,745.20
Rate for Payer: BCBS of TX Medicare	$1,659.12
Rate for Payer: BCBS of TX PPO	$3,458.95
Rate for Payer: Cash Price	$4,407.05
Rate for Payer: Cash Price	$4,407.05
Rate for Payer: Cash Price	$4,407.05
Rate for Payer: Cigna Commercial	$3,507.10
Rate for Payer: Cigna Medicaid	$4,666.29
Rate for Payer: Cigna Medicare	$1,659.12
Rate for Payer: Employer Direct Commercial	$1,659.12
Rate for Payer: Humana Medicare/TRICARE	$1,659.12
Rate for Payer: Molina CHIP/Medicaid	$4,666.29
Rate for Payer: Molina Dual Medicare/Medicaid	$1,659.12
Rate for Payer: Molina Medicare	$1,659.12
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Parkland Medicaid	$4,666.29
Rate for Payer: Scott and White EPO/PPO	$3,069.37
Rate for Payer: Scott and White Medicare	$1,659.12
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,666.29
Rate for Payer: Superior Health Plan EPO	$1,659.12
Rate for Payer: Superior Health Plan Medicare	$1,659.12
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,659.12
Rate for Payer: Universal American Medicare	$1,659.12
Rate for Payer: Wellcare Medicare	$1,659.12
Rate for Payer: Wellmed Medicare	$1,659.12

Debride Bone First 20 Sq cm or Less

Facility

$6,480.96

Service Code	HCPCS 11044
Hospital Charge Code	9900084
Hospital Revenue Code	360
Rate for Payer: Cash Price	$4,407.05

Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if perform

Facility

$10,000.00

Service Code	CPT 11044
Hospital Charge Code	36011044
Hospital Revenue Code	360
Min. Negotiated Rate	$566.62
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$566.62
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,659.12
Rate for Payer: Amerigroup Medicare	$1,659.12
Rate for Payer: BCBS of TX Blue Advantage	$2,292.24
Rate for Payer: BCBS of TX Blue Essentials	$2,745.20
Rate for Payer: BCBS of TX Medicare	$1,659.12
Rate for Payer: BCBS of TX PPO	$3,458.95
Rate for Payer: Cigna Commercial	$3,507.10
Rate for Payer: Cigna Medicare	$1,659.12
Rate for Payer: Employer Direct Commercial	$1,659.12
Rate for Payer: Humana Medicare/TRICARE	$1,659.12
Rate for Payer: Molina Dual Medicare/Medicaid	$1,659.12
Rate for Payer: Molina Medicare	$1,659.12
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Scott and White EPO/PPO	$3,069.37
Rate for Payer: Scott and White Medicare	$1,659.12
Rate for Payer: Superior Health Plan EPO	$1,659.12
Rate for Payer: Superior Health Plan Medicare	$1,659.12
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,659.12
Rate for Payer: Universal American Medicare	$1,659.12
Rate for Payer: Wellcare Medicare	$1,659.12
Rate for Payer: Wellmed Medicare	$1,659.12

Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (eg, excisional debridement); skin, subcutaneous tissue, muscle fascia, muscle, and bone

Facility

$16,590.07

Service Code	HCPCS 11012
Hospital Charge Code	9900081
Hospital Revenue Code	360
Min. Negotiated Rate	$815.20
Max. Negotiated Rate	$11,944.85
Rate for Payer: Amerigroup CHIP/Medicaid	$815.20
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$2,917.95
Rate for Payer: Amerigroup Medicare	$2,917.95
Rate for Payer: BCBS of TX Blue Advantage	$3,872.55
Rate for Payer: BCBS of TX Blue Essentials	$4,637.78
Rate for Payer: BCBS of TX Medicare	$2,917.95
Rate for Payer: BCBS of TX PPO	$5,843.60
Rate for Payer: Cash Price	$11,281.25
Rate for Payer: Cash Price	$11,281.25
Rate for Payer: Cash Price	$11,281.25
Rate for Payer: Cigna Commercial	$6,168.03
Rate for Payer: Cigna Medicaid	$11,944.85
Rate for Payer: Cigna Medicare	$2,917.95
Rate for Payer: Employer Direct Commercial	$2,917.95
Rate for Payer: Humana Medicare/TRICARE	$2,917.95
Rate for Payer: Molina CHIP/Medicaid	$11,944.85
Rate for Payer: Molina Dual Medicare/Medicaid	$2,917.95
Rate for Payer: Molina Medicare	$2,917.95
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Parkland Medicaid	$11,944.85
Rate for Payer: Scott and White EPO/PPO	$5,398.21
Rate for Payer: Scott and White Medicare	$2,917.95
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11,944.85
Rate for Payer: Superior Health Plan EPO	$2,917.95
Rate for Payer: Superior Health Plan Medicare	$2,917.95
Rate for Payer: Universal American Dual Medicare/Medicaid	$2,917.95
Rate for Payer: Universal American Medicare	$2,917.95
Rate for Payer: Wellcare Medicare	$2,917.95
Rate for Payer: Wellmed Medicare	$2,917.95

Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (eg, excisional debridement); skin, subcutaneous tissue, muscle fascia, muscle, and bone

Facility

$16,590.07

Service Code	HCPCS 11012
Hospital Charge Code	9900081
Hospital Revenue Code	360
Rate for Payer: Cash Price	$11,281.25

Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed

Facility

$10,000.00

Service Code	CPT 11043
Hospital Charge Code	36011043
Hospital Revenue Code	360
Min. Negotiated Rate	$262.63
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$262.63
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$742.44
Rate for Payer: Amerigroup Medicare	$742.44
Rate for Payer: BCBS of TX Blue Advantage	$830.02
Rate for Payer: BCBS of TX Blue Essentials	$994.04
Rate for Payer: BCBS of TX Medicare	$742.44
Rate for Payer: BCBS of TX PPO	$1,252.49
Rate for Payer: Cigna Commercial	$1,569.38
Rate for Payer: Cigna Medicare	$742.44
Rate for Payer: Employer Direct Commercial	$742.44
Rate for Payer: Humana Medicare/TRICARE	$742.44
Rate for Payer: Molina Dual Medicare/Medicaid	$742.44
Rate for Payer: Molina Medicare	$742.44
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Scott and White EPO/PPO	$1,373.51
Rate for Payer: Scott and White Medicare	$742.44
Rate for Payer: Superior Health Plan EPO	$742.44
Rate for Payer: Superior Health Plan Medicare	$742.44
Rate for Payer: Universal American Dual Medicare/Medicaid	$742.44
Rate for Payer: Universal American Medicare	$742.44
Rate for Payer: Wellcare Medicare	$742.44
Rate for Payer: Wellmed Medicare	$742.44

Know your out-of-pocket cost for care.

All Charges